4491 - Laserfiche WebLink

Home Browse Search

53 '� APPLICATION FOR SANITATION PERMIT Permit No. -----!/K------------ � Com lete in Duplicate)p � P pate Issued ---- Application ..-Application ' ereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. " JOB ADDRESS AND LOCATION-----P- - ----------16 ----- ------------------------------------•----..-.--r-�------------------------ ---- 8 - s8- Owner's Name------- ------------- Phone- OS v? �� . Address �- ----------- ---------- ---- ------------------------------------------------------- - /, / Contractor's Name------,-- �� -------------------------------------------•----------- ------ Phone--7-.Q4' 6---------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ,-.- Number of bedrooms -2. Number of baths ./- Lot size ----- r ---------------------- i Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table 14`14 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeZ Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---- .--..Distance from foundation----- .--...._..Material--------------- ------------- No. of compartments-------- - ---- .S i�6 a s 9 p. p Y }d d �( "2'- --- - Size-- -----x- ---�- - ----Liquid id de th----yl.�----- -----._Cape D-------- --- $ 47� Disposal Field: Distance from nearest well-_4.a:._----Distance from foundation.-.--s-----.......Distance to nearest lot line--------- Number of lines------.._./---------------------Length of each line----- -Q..�--------__-_--.Width of trench------ -y_ ------------------- Type of filter, material-S.�4-c�.------Depth of filter material_____/ - -------Total length---------3-_ ------------------------- i Seepage Pit: Distance to nearest well—9A�....-.....pistanc�j from foundation...-A0_------...Distance to nearest lot line.._..�..... Number of pits-------L----------Lining material_4 .Size: Diameter--.--_jA` ------Depth..---�5l---------------- +4 Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining material--.---------------------------------- R Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity--------------:-------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-._....--------_-._..---------_._._... ❑ Distance to nearest lot line------------------------- ------------------- ------------------------- ----------------------------------------------------- Remodelingand/or repairing {describe)-------------------------------------------------------••-•----•-----------•----------------------------------------------------------------------------- ------------------------•--------------------------------------------------------------------•-•----------------------------------------------------------------------------------- --•------------------------------------ - - --------•--•--- ------- ------------•-•------------...------------------------------------------•---------------------------------------------------- -- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 'E (Signed) -----�------!------ ----------------------------- ---------------------------------------------------------------------Owner and/or Contractor gy:---------- - ...-W--- ----------------------------- -----------------------------------(Title) --------------------------------- (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ---- --------------------------------------------------- DATE------------- t --r-- - T-- ---- ---------------- REVIEWEDBY----------------------------------------------------------- --------------------------------- DATE------------- BUILDING PERMIT ISSUED--------------------------------------------- ----------•--------------------•--•--------------------- DATE-------------------------------------------------•-----••---- Alterationsand/or recommendations:-------------- --------------- ----- --------------------------•-- ------------------------------------------......---- ----------------------.-----.-----•- -------------------- ---------------------------------•---•----------------------------------------------------------- ------------------------------•------------------------------•---•- -----------------•--------------- ------------------------------------ ------------------------------•------------------------------------------ ----------------------------------••-------------------------------------------------------------•-------- FINAL INSPECTION BY:. � .----� --------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT `f 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street '* Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100